Medical Staff Attitudes Toward Family Presence during Pediatric Procedures

Objective: Investigate health care providers' perceived advantages and disadvantages of family member presence (FMP) for a wide spectrum of procedures in the pediatric emergency department. Setting: Urban tertiary care children's hospital. Participants: Pediatric emergency department faculty and nurses, pediatric residents. Methods: In a written survey, participants rated approval of FMP for 9 procedures: intravenous (IV) placement, urinary catheterization, suturing, lumbar puncture, fracture reduction, chest tube placement, endotracheal intubation, medical resuscitation, and trauma resuscitation. Respondents listed advantages and disadvantages of FMP for patients, families, and staff. Results: 71% (104/146) of the surveys were completed. Attending physicians and nurses provided similarly high approval rating for less invasive procedures, with a decrement in approval for more invasive or life-threatening situations. Attending physicians and nurses were more likely than residents to approve FMP for all procedures except IV placement, suturing, and urinary catheterization, which had similar approval rates for all respondents. Commonly expressed potential advantages were ability to calm the patient, decreased parental "helplessness," and increased parental knowledge that everything was done. Disadvantages included higher anxiety in room, disturbing parental memories, and detriment to success of the procedure. Medical-legal concerns, mistrust of providers, and more difficult teaching environment were uncommonly listed as disadvantages. Conclusions: Emergency department staff support FMP for minor procedures, yet express concern regarding the effects of this practice on the family and the success of the procedure. Most attending physicians and nurses support FMP during highly invasive procedures and resuscitations, whereas residents do not. This information provides insight into the educational and systematic requirements of implementation of FMP.